Take a look at the top challenges facing the market research industry today

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Take a look at the top challenges facing the market research industry today.  Write a blog that focuses on one of the issue categories and is related to ethics

As described in Chapter 3 of e-text, “Strategic planning is the managerial decision process that matches a firm’s resources (such as its financial assets and workforce) and capabilities

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As described in Chapter 3 of e-text, “Strategic planning is the managerial decision process that matches a firm’s resources (such as its financial assets and workforce) and capabilities (the things it is able to do well because of its expertise and experience) to its market opportunities for long-term growth.

For this discussion, please answer the following:

Why do you think Strategic Planning is important to a company, organization?
Identify a company; organization in which you believe uses Strategic Planning effectively for its competitive advantage? And, tell us the two competitive advantages that the company, the organization has or uses to differentiate itself over its competition?

Of the four growth strategies described in class, the strategy is typically the most challenging due to limited prior experience with the market as well as the product category.

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Of the four growth strategies described in class, the strategy is typically the most challenging due to limited prior experience with the market as well as the product category. 0 product expansion 0 market development 0 product development 0 market penetration O diversification

An Employee training session

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Part 1 Training Design. In this discussion forum, you will be developing an employee training session.

For this discussion, you are tasked with designing a 4-hour leadership development training session. In this discussion,

· Identify specific learning objectives for your training session.

· Conduct an Internet search to identify the types of games and business simulations that are available. Select one game or business simulation appropriate for your audience and learning objectives.

· Analyze the game or business simulation as it pertains to your specific audience and learning objectives. Do not simply cut and paste from the Internet source.

Directions: Your initial post should be 250 to 300 words. Use this week’s lecture and Chapter 5, 6, and 7 as a foundation for your initial post. In addition to the Blanchard and Thacker (2019) text, use at least one additional scholarly source to support your discussion.

Part 2 Training Delivery 

In this discussion forum you will evaluate your previous workplace learning experiences. In your initial discussion post,

· Describe the training delivery method(s) used in your best prior workplace learning experience.

o Identify the factors that contributed to making it an effective workplace learning experience.

· Describe the training delivery method(s) used in your worst prior workplace learning experience.

o Identify the factors that contributed to making it an ineffective workplace learning experience.

o Discuss what you would suggest to make each workplace learning experience more effective.

 

Required Resource

Text

Blanchard, P. N., & Thacker, J. W. (2019). Effective training: Systems, strategies, and practices (6th ed.). Chicago Business Press.

  • Chapter 5: Training Design
  • Chapter 6: Traditional Training Methods
  • Chapter 7: Electronic Training Methods
  • The full-text version of this ebook is available in your online classroom through the Redshelf platform. Chapter 5 discusses the value of designing an effective training program in an organization, Chapter 6 discusses traditional training methods with an organization, and Chapter 7 discusses advanced training methods including electronic training in an organization. These chapters will assist you in the discussion forums and written assignment for this week.

Explain how new developments in technology help to build successful customer relationships

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Explain how new developments in technology help to build successful customer relationships.

  • Conclusion:
    • Conduct (research) and explain two (2) ways how companies could successfully monitor customer satisfaction through technology.

The Management functions

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How do the management functions relate to change? How does the systems effect relate to the four variables of change?

3. List the four stages in the change process.

4. Which of the five reasons for resisting change do you believe is most common?

5. Which of the six ways to overcome resistance to change do you believe is the most important?

6. Select two sport organizations and discuss the differences between their cultures.

7. Discuss how the two types of innovations could be used by a manufacturer of golf balls.

8. Discuss how you would use team building to improve the effectiveness of a team you are playing on or have played for.

9. Do you agree with the core values of TQM? If not, how would you change them?

10. Do you believe that online surveys are an effective method for analyzing the effectiveness of Title IX in the United States?

11. Do you consider yourself to be a creative, innovative person? Why or why not?

12. How has diversity affected you personally?

13. Should men break the glass ceiling and promote more women to top positions? Why or why not?

14. Should the government get involved in breaking the glass ceiling? Why or why not? If yes, what should the government do? State pros and cons of government involvement.

15. Do you believe that it is acceptable for people who work together to date each other?

16. Do you have a mentor? Will you get one? Why or why not?

17. As a manager, which, if any, OD interventions will you use?

 

 

How does target use Strategic Planning effectively for its competitive advantage?

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How does target use Strategic Planning effectively for its competitive advantage? what are two competitive advantages that Target has or uses to differentiate itself over its competition?

The Reign of the Farmer James E. McClellan

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The Reign of the Farmer James E. McClellan and Harold Dorn At the end of the last Ice Age, around 12,000 years ago, the Neolithic Revolution

began to unfold. This revolution, first and foremost a socioeconomic and

technological transformation, involved a shift from food gathering to food

producing. It originated in a few regions before eventually spreading around the

globe. In habitats suitable only as pasture it led to pastoral nomadism or herding

animal flocks; in others it led to farming and settled village life. Thus arose the

Neolithic or New Stone Age.

Growing Your Own

A surprising but grand fact of prehistory: Neolithic communities based on

domesticated plants and animals arose independently several times in different

parts of the world after 10,000 bce—the Near East, India, Africa, North Asia,

Southeast Asia, and Central and South America. The physical separation of the

world’s hemispheres—the Old World and the New World—decisively argues

against simple diffusion oef Neolithic techniques, as do the separate domestications

of wheat, rice, corn, and potatoes in different regions. On the time scale of

prehistory the transformation appears to have been relatively abrupt, but in fact the

process occurred gradually. Nonetheless, the Neolithic revolution radically altered

 

 

the lives of the peoples affected and, indirectly, the conditions of their habitats.

Although different interpretations exist concerning the origin of the Neolithic, no

one disputes its worldtransforming effects.

The Neolithic was the outcome of a cascading series of events and processes. In

the case of gardening—lowintensity farming—we now know that in various

locales around the world human groups settled down in permanent villages, yet

continued to practice hunting, gathering, and a Paleolithic economy before the full

transition to a Neolithic mode of production. These settled groups lived by

complex foraging in limited territories, intensified plant collection, and

exploitation of a broad spectrum of secondary or tertiary food sources, such as nuts

and seafood. They also lived in houses, and in this sense early sedentary humans

were themselves a domesticated species. (The English word “domestic” derives

from the Latin word domus, meaning “house.” Humans thus domesticated

themselves as they domesticated plants or animals!) But the inexorable pressure of

population against dwindling collectible resources, along with the greater

nutritional value of wild and domesticated cereal grains, ultimately led to

increasing dependence on food production and a more complete food producing

way of life. In most places in the world people continued a Paleolithic existence

after the appearance of Neolithic settlements 12,000 years ago. They were

 

 

blissfully unpressured to take up a new Neolithic mode of food producing, and as a

cultural and economic mode of existence even today a few surviving groups follow

a Paleolithic lifestyle. As a period in prehistory, the Neolithic has an arc of its own

that covers developments from the first simple horticulturists and pastoralists to

complex late Neolithic groups living in “towns.” In retrospect, especially compared

to the extreme length of the Paleolithic period, the Neolithic of prehistory lasted

just a moment before civilization in Mesopotamia and Egypt began to usher in

further transformations around 5,000 years ago. But even in its diminished time

frame the Neolithic spread geographically and persisted in particular locales over

thousands of years from roughly 12,000 to 5,000 years ago, when the Neolithic

first gave way to civilization in the Near East. To those experiencing it, Neolithic

life must have proceeded over generations at a leisurely seasonal pace.

Two alternative paths toward food production led out of the Paleolithic: one from

gathering to cereal horticulture (gardening), and then to plow agriculture; the other

from hunting to herding and pastoral nomadism. A distinct geography governed

these Neolithic alternatives: In climates with sufficient atmospheric or surface

water, horticulture and settled villages arose; in grasslands too arid for farming,

nomadic people and herds of animals retained a nomadic way of life. Of these very

different paths, one led historically to nomadic societies such as the Mongols and

 

 

the Bedouins. The other, especially in the form that combined farming and

domestication of animals, led to the great agrarian civilizations and eventually to

industrialization. Opportunistic and even systematic hunting and gathering

persisted alongside foodproducing, but where Neolithic settlements arose the basic

economy shifted to raising crops on small cleared plots. Gardening contrasts with

intensified agriculture using irrigation, plows, and draft animals, which later

developed in the first civilizations in the Near East. Early Neolithic peoples did not

use the plow but, where necessary, cleared land using large stone axes and adzes;

they cultivated their plots using hoes or digging sticks. In many areas of the world,

especially tropical and subtropical ones, swidden, or “slash and burn,” agriculture

developed where plots were cultivated for a few years and then abandoned to

replenish themselves before being cultivated again. The Neolithic toolkit continued

to contain small chipped stones, used in sickles, for example, but was augmented

by larger, often polished implements such as axes, grinding stones, and mortars and

pestles found at all Neolithic sites. Animal antlers also proved useful as picks and

digging sticks. And grain had to be collected, threshed, winnowed, stored, and

ground, all of which required an elaborate set of technologies and social practices.

Human populations around the world independently domesticated and began

cultivating a variety of plants: several wheats, barleys, rye, peas, lentils, and flax in

Southwest Asia; millet and sorghum in Africa; millet and soybeans in North China;

 

 

rice and beans in Southeast Asia; maize (corn) in Mesoamerica; potatoes, quinoa,

manioc, and beans in South America. Domestication constitutes a process (not an

act) that involves taming, breeding, genetic selection, and occasionally introducing

plants into new ecological settings. In the case of wheat, for example, wild wheat is

brittle, with seeds easily scattered by the wind and animals, a trait that enables the

plant to survive under natural conditions. Domesticated wheat retains its seeds,

which simplifies harvesting but leaves the plant dependent on the farmer for its

propagation. Humans changed the plant’s genes; the plant changed humanity. And,

with humans raising the grain, the rat, the mouse, and the house sparrow

“selfdomesticated” and joined the Neolithic ark.

The domestication of animals developed out of intimate and longstanding human

contact with wild species. Logically, at least, there is a clear succession from

hunting and following herds to corralling, herding, taming, and breeding. The

living example of the Sami (Lapp) people who follow and exploit semiwild

reindeer herds illustrates how the shift from hunting to husbandry and pastoral

nomadism may have occurred. As with plant culture, the domestication of animals

involved human selection from wild types, selective slaughtering, selective

breeding, and what Darwin later called “unconscious selection” from among flocks

and herds. Humans in the Old World domesticated cattle, goats, sheep, pigs,

 

 

chickens, and, later, horses. In the New World Andean communities domesticated

only llamas and the guinea pig; peoples in the Americas thus experienced a

comparative deficiency of animal protein in the diet.

Animals are valuable to humans in diverse ways. Some of them convert inedible

plants to meat, and meat contains more complex proteins than plants. Animals

provide food on the hoof, food that keeps from spoiling until needed. Animals

produce valuable secondary products that were increasingly exploited as the

Neolithic unfolded in the Old World. Cattle, sheep, pigs, and the rest are “animal

factories” that produce more cattle, sheep, and pigs. Chickens lay eggs, and cows,

sheep, goats, and horses produce milk. Treated and storable milk products in

yogurts, cheeses, and brewed beverages sustained the great herding societies of

Asia and pastoralists everywhere. Manure became another valuable animal product

as fertilizer and fuel. Animal hides provided raw material for leather and a variety

of products, and sheep, of course, produced fleece. (Wool was first woven into

fabric on Neolithic looms.) Animals provided traction and transportation. The

Neolithic maintained the close dependence on plants and animals that humankind

had developed over the previous 2 million years. But the technologies of exploiting

them and the social system sustained by those technologies had changed radically.

 

 

After a few thousand years of the Neolithic in the Near East, mixed economies that

combined the technologies of horticulture and animal husbandry made their

appearance. Late Neolithic groups in the Old World apparently kept animals for

traction and used wheeled carts on roads and pathways that have been favorably

compared to those of medieval Europe. The historical route to intensified

agriculture and to civilization was through this mixed Neolithic farming. If biology

and evolution were partly responsible for the character of our first mode of

existence in the Paleolithic, then the Neolithic Revolution represents a change of

historical direction initiated by humans themselves in response to their changing

environment.

Complementing the many techniques and skills involved in farming and

husbandry, several ancillary technologies arose as part of the shift to the Neolithic.

First among these novelties was textiles, an innovation independently arrived at in

various parts of the Old and New Worlds. Recent findings show that some

Paleolithic groups occasionally practiced techniques of weaving, perhaps in

basketry, but only in the Neolithic did the need for cloth and storage vessels

expand to the point where textile technologies flourished. The production of

textiles involves several interconnected steps and technological practices: shearing

sheep or growing and harvesting flax or cotton, processing the raw material,

 

 

spinning thread (an everpresent part of women’s lives until the Industrial

Revolution 10,000 years later), constructing looms, dyeing, and weaving the cloth.

In considering the advent of textile production in the Neolithic, one cannot

overlook design considerations and the symbolic and informational role of dress in

all societies. Then, as now, how people dress conveys a lot of information about

who they are and where they come from.

Pottery, which also originated independently in multiple centers around the world,

is another new technology that formed a key part of the Neolithic Revolution. If

only inadvertently, Paleolithic peoples had produced firedclay ceramics, but

nothing in the Paleolithic economy called for a further development of the

technique. Pottery almost certainly arose in response to the need for a storage

technology: jars or vessels to store and carry the surplus products of the first

agrarian societies. Neolithic communities used plasters and mortars in building

construction, and pottery may have arisen out of plastering techniques applied to

baskets. Eventually, “manufacturing centers” and smallscale transport of ceramics

developed. Pottery is a “pyrotechnology,” for the secret of pottery is that

chemically combined water is driven from the clay when it is fired, turning it into

an artificial stone. Neolithic kilns produced temperatures upwards of 900°C. Later,

 

 

in the Bronze and Iron Ages, the Neolithic pyrotechnology of pottery made

metallurgy possible.

In Neolithic settings, hundreds if not thousands of techniques and technologies

large and small melded to produce the new mode of life. Neolithic peoples built

permanent structures in wood, mud brick, and stone, all of which testify to expert

craft skills. They twisted rope and practiced lapidary crafts, and Neolithic peoples

even developed metallurgy of a sort, using naturally occurring raw copper. The

technology of cold metalworking produced useful tools. The now famous “Ice

man,” the extraordinary frozen mummy exposed in 1991 by a retreating glacier in

the Alps, was first thought to belong to a Bronze Age culture because of the fine

copper axe he was carrying when he perished. As it turns out, he lived in Europe

around 3300 bce, evidently a prosperous Neolithic farmer with a superior cold

forged metal tool.

The Neolithic was also a social revolution and produced a radical change in

lifeways. Decentralized and self-sufficient settled villages, consisting of a dozen to

two dozen houses, with several hundred inhabitants became the norm among

Neolithic groups. Compared to the smaller bands of the Paleolithic, village life

supported collections of families united into tribes. The Neolithic house doubtless

 

 

became the center of social organization; production took place on a household

basis. The imaginative suggestion has been made that living inside houses forced

Neolithic peoples to deal in new ways with issues concerning public space,

privacy, and hospitality. Neolithic peoples may have used hallucinatory drugs, and

they began to experiment with fermented beverages. Although a sexual division of

labor probably persisted in the Neolithic, horticultural societies, by deemphasizing

hunting, may have embodied greater gender equality. A comparatively sedentary

lifestyle, a diet higher in carbohydrates, and earlier weaning increased fertility,

while freedom from the burden of carrying infants from camp to camp enabled

women to bear and care for more children. And one suspects that the economic

value of children—in tending animals or helping in the garden, for example—was

greater in Neolithic times than in the Paleolithic. At least with regard to Europe,

archaeologists have made compelling claims for the existence of cults devoted to

Neolithic goddesses and goddess worship. There were doubtless shamans, or

medicine “men,” some of whom may also have been women. Neolithic societies

remained patriarchal, but males were not as dominant as they would become with

the advent of civilization.

In the early Neolithic, little or no occupational specialization differentiated

individuals who earned their bread solely through craft expertise. This

 

 

circumstance changed by the later Neolithic, as greater food surpluses and

increased exchange led to more complex and wealthier settlements with fulltime

potters, weavers, masons, toolmakers, priests, and chiefs. Social stratification kept

pace with the growth of surplus production. By the late Neolithic, low level

hierarchal societies, tribal chiefdoms, or what anthropologists call “big men”

societies appeared. These societies were based on kinship, ranking, and the power

to accumulate and redistribute goods sometimes in great redistributive feasts.

Leaders now controlled the resources of 5,000 to 20,000 people. They were not yet

kings, however, because they retained relatively little for themselves and because

Neolithic societies were incapable of producing truly huge surpluses.

Compared to the Paleolithic economy and lifestyle, one could argue that the

standard of living actually became depressed in the transition to the Neolithic in

that lowintensity horticulture required more labor, produced a less varied and

nutritious diet, and allowed less leisure than Paleolithic hunting and gathering in its

heyday. But—and this was the primary advantage—Neolithic economies produced

more food and could therefore support more people and larger population densities

(estimated at a hundredfold more per square mile) than Paleolithic foraging.

 

 

Populations expanded and the Neolithic economy spread rapidly to fill suitable

niches. By 3000 bce thousands of agrarian villages dotted the Near East, usually

within a day’s walk of one another. Wealthier and more complex social structures

developed, regional crossroads and trading centers arose, and by the late Neolithic

real towns had emerged. The Neolithic town Çatal Hüyük in modern Turkey dates

from 6000 bce, but the classic example is the earlier and especially rich Neolithic

town of Jericho. Neolithic settlements appeared along the Jordon River in the

Middle East by 9000 bce, and by 7350 bce Jericho itself had become a

wellwatered, brickwalled city of 2,000 or more people tending flocks and plots in

the surrounding hinterland. Jericho had a tower nine meters high and ten meters in

diameter, and its celebrated walls were three meters thick, four meters high, and

700 meters in circumference. The walls were necessary because the surplus stored

behind them attracted raiders. The later walled enclosure at Great Zimbabwe (c.

1300 ce) in Africa evidences similar forces at play. Warlike clashes between

Paleolithic peoples had undoubtedly occurred repeatedly over the millennia in

disputes over territory, to capture females, or for cannibalistic or ritual purposes.

But with the Neolithic, for the first time, humans produced surplus food and wealth

worth stealing and hence worth protecting. Paleolithic groups were forced to adapt

to the Neolithic economies burgeoning around them. Thieving was one alternative;

joining in a settled way of life was another. In the long run, Neolithic peoples

 

 

marginalized huntergatherers and drove them virtually to extinction. Idealized

memories of the foraging lifestyle left their mark in “Garden of Eden” or “happy

hunting grounds” legends in many societies.

Blessed or cursed with a new economic mode of living, humans gained greater

control over nature and began to make more of an impact on their environments.

The ecological consequences of the Neolithic dictated that the domestic replace the

wild, and where it occurred the Neolithic Revolution proved irreversible—a return

to the Paleolithic was impossible because Paleolithic habitats had been transformed

and the Paleolithic lifestyle was no longer sustainable.

Moonshine

The Neolithic Revolution was a technoeconomic process that occurred without the

aid or input of any independent “science.” In assessing the connection between

technology and science in the Neolithic, pottery provides an example exactly

analogous to making fire in the Paleolithic. Potters made pots simply because pots

were needed and because they acquired the necessary craft knowledge and skills.

Neolithic potters possessed practical knowledge of the behavior of clay and of fire,

and, although they may have had explanations for the phenomena of their crafts,

they toiled without any systematic science of materials or the selfconscious

 

 

application of theory to practice or any higher learning to tap for practical

purposes. It would denigrate Neolithic crafts to suppose that they could have

developed only with the aid of higher learning.

Can anything, then, be said of science in the Neolithic? In one area, with regard to

what can be called Neolithic astronomy, we stand on strong ground in speaking

about knowledge in a field of science. Indeed, considerable evidence makes plain

that many, and probably most, Neolithic peoples systematically observed the

heavens, particularly the patterns of motion of the sun and moon and that they

regularly created astronomically aligned monuments that served as seasonal

calendars. In the case of Neolithic astronomy, we are dealing not with the

prehistory of science, but with science in prehistory.

The famous monument of Stonehenge on the Salisbury Plain in southwest England

provides the most dramatic and best understood case in point. Stonehenge, it has

now been determined by radiocarbon dating, was built intermittently in three major

phases by different groups over a 1,600 year period from 3100 bce to 1500 bce, by

which time the Bronze Age finally washed across the Salisbury Plain. The word

“Stonehenge” means “hanging stone,” and transporting, working, and erecting the

 

 

huge stones represents a formidable technological achievement on the part of the

Neolithic peoples of prehistoric Britain.

A huge amount of labor went into building Stonehenge—estimates range to 30

million manhours, equivalent to an annual productive labor of 10,000 people. In

order to create a circular ditch and an embankment 350 feet in diameter 3,500

cubic yards of earth were excavated. Outside the sanctuary the first builders of

Stonehenge erected the so-called Heel Stone, estimated to weigh 35 tons.

Eightytwo “bluestones” weighing approximately 5 tons apiece were brought to the

site (mostly over water) from Wales, an incredible 240 kilometers (150 miles)

away. Each of the 30 uprights of the outer stone circle of Stonehenge weighed in

the neighborhood of 25 tons, and the 30 lintels running around the top of the ring

weighed 7 tons apiece. More impressive still, inside the stone circle stood the five

great trilithons or threestone behemoths. The average trilithon upright weighs 30

tons and the largest probably weighs over 50 tons. (By contrast, the stones that

went into building the pyramids in Egypt weighed on the order of 5 tons.) The

great monoliths were transported 40 kilometers (25 miles) overland from

Marlborough Downs, although the suggestion has been made that ancient glaciers

may have been responsible for moving them at least part way to Stonehenge. The

architects of Stonehenge appear to have laid out the monument on a true circle, and

 

 

in so doing they may have used some practical geometry and a standard measure,

the so-called megalithic yard.

The labor was probably seasonal, taking place over generations. A stored food

surplus was required to feed workers, and some relatively centralized authority was

needed to collect and distribute food and to supervise construction. Neolithic

farming and ranching communities appeared on the Salisbury Plain by the fourth

millennium bce and evidently reached the required level of productivity. Although

Neolithic farming never attained the levels of intensification later achieved by

civilized societies, Stonehenge and the other megalithic (“large stone”) structures

show that even comparatively low intensity agriculture can produce sufficient

surpluses to account for monumental building.

Recognition that Stonehenge is an astronomical device has been confirmed only in

our day. As literate peoples encountered Stonehenge over the centuries, any

number of wild interpretations emerged as to who built it and why. Geoffrey of

Monmouth in his twelfth century History of the Kings of Britain has Merlin from

King Arthur’s court magically transporting the stones from Wales. Other authors

have postulated that the Romans or the Danes built Stonehenge. A still current

fantasy holds that the Druids built and used Stonehenge as a ceremonial center. (In

 

 

fact, the Celtic Iron Age Druids and their culture only appeared a thousand years

after Stonehenge was completed.) Even in the 1950s, when the possibility became

clear that Neolithic peoples from the Salisbury Plain themselves were responsible

for Stonehenge, there was considerable resistance to the idea that “howling

barbarians” might have been capable of building such an impressive monument,

and some supposed that itinerant contractors from the Near East built it. All

scholars now agree that Stonehenge was a major ceremonial center and cult site

built by the people of the Salisbury Plain. Its astronomical uses indicate that it

functioned as a ceremonial center aligned around the motions of the sun and the

moon and it provided the basis for a regional calendar.

The English antiquarian William Stukeley (1687–1765) was the first modern to

write about the solar alignment of Stonehenge in 1740. The sun rises every day at a

different point on the horizon; that point moves back and forth along the horizon

over the course of a year, and each year at midsummer the sun, viewed from the

center of the sanctuary at Stonehenge, rises at its most northern point, which is

precisely where the builders placed the Heel Stone. The monument’s primary

astronomical orientation toward the midsummer sunrise is confirmed annually and

has not been disputed since Stuckeley.

 

 

In the 1960s, however, controversy erupted over claims for Stonehenge as a

sophisticated Neolithic astronomical “observatory” and “computer.” The matter

remains disputed today, but wide agreement exists on at least some larger

astronomical significance for Stonehenge, especially with regard to tracking

cyclical movements of the sun and the moon. The monument seems to have been

built to mark the extreme and mean points of seasonal movement of both heavenly

bodies along the horizon as they rise and set. Thus, the monument at Stonehenge

marks not only the sun’s rise at the summer solstice, but the rise of the sun at

winter solstice and at the fall and spring equinoxes. It also indicates the sun’s

settings at these times, and it tracks the more complicated movements of the moon

back and forth along the horizon, marking four different extremes for lunar motion.

The construction of Stonehenge required sustained observations of

the sun and the moon over a period of decades and mastery of horizon astronomy.

The monument embodied such observations, even in its earliest phases. The ruins

testify to detailed knowledge of heavenly movements and to a widespread practice

of “ritual astronomy.” We have no access to what megalithic Europeans thought

they were doing; their “theories” of the sun and the moon, if any, may have been

utterly fantastic, and we would probably label their explanations more religious

than naturalistic or scientific. Still, megalithic monuments embody a scientific

 

 

approach in that they reflect understanding of regularities of celestial motions and

they bespeak longterm systematic observations of nature. Paleolithic peoples knew

of the periodic motion of the sun and the moon, of course, but to create a Neolithic

monument like Stonehenge that records these longerterm motions along the

horizon required careful observation and (presumably oral) recordkeeping over

many years, probably over generations. In this way the knowledge accumulated

and embodied in Stonehenge required a degree of organization and systematization

not seen in the historical record to that point. Although religious elders, hereditary

experts, or priestly keepers of knowledge doubtless built and tended Stonehenge, it

probably goes too far to suggest that megalithic monuments provide evidence for a

class of professional astronomers or for astronomical research of the sort that later

appeared in the first civilizations. Stonehenge may better be thought of as a

celestial orrery or clock that kept track of the major motions of the major celestial

bodies and possibly some stars. In addition, Stonehenge certainly functioned as a

seasonal calendar, accurate and reliable down to a day. As a calendar, Stonehenge

kept track of the solar year and, even more, harmonized the annual motion of the

sun with the more complicated periodic motion of the moon. It may even have

been used to predict eclipses. In these telling ways—systematically observing the

heavens, mastering the clocklike movement of the sun and the moon, gaining

intellectual control over the calendar—it is possible and even necessary to speak of

 

 

Neolithic “astronomy” at Stonehenge. The further development of astronomy

awaited the advent of writing and cohorts of fulltime experts with the patronage of

centralized bureaucratic governments. But long before those developments,

Neolithic farmers systematically investigated the panorama of the heavens.

On the other side of the globe the remarkable giant statues of Easter Island (also

known as Rapa Nui) provide mute testimony to the same forces at play. Easter

Island is small and very isolated: a 46-square-mile speck of land 1,400 miles west

of South America and 900 miles from the nearest inhabited Pacific island.

Polynesian peoples reached Easter Island by sea sometime after 300 ce and

prospered through cultivating sweet potatoes, harvesting in a subtropical palm

forest, and fishing in an abundant sea. The economy was that of settled Paleolithic

or simple Neolithic societies, but local resources were rich, and even at slow

growth rates over a millennium the founding population inevitably expanded,

reaching 7,000 to 9,000 at the peak of the culture around 1200 to 1500 ce. (Some

experts put the figure at over 20,000.)

Islanders carved and erected more than 250 of their monumental moai statues on

giant ceremonial platforms facing the sea. Notably, the platforms possessed built-in

astronomical orientations. Reminiscent of the works of the peoples of Stonehenge

 

 

or the Olmecs of Central America, the average moai stood over 12 feet in height,

weighed nearly 14 tons, and was transported up to six miles overland by gangs of

55 to 70 men; a few mammoth idols rose nearly 30 feet tall and weighed up to 90

tons. Hundreds more statues—some significantly larger still—remain unfinished in

the quarry, where all activity seems to have stopped abruptly. Remote Easter Island

became completely deforested because of the demand for firewood and

construction material for seagoing canoes, without which islanders could not fish

for their staple of porpoise and tuna. By 1500, with the elimination of the palm tree

and the extinction of native bird populations, demographic pressures became

devastatingly acute, and islanders intensified chickenraising and resorted to

cannibalism and eating rats. The population quickly crashed to perhaps onetenth its

former size, the sad remnant “discovered” by Europeans in 1722. Only 100 souls

lived there in 1887. The wealth of the pristine island had provided rich resources

where a human society evolved in a typically Neolithic (or settled Paleolithic)

pattern. But human appetites and the island’s narrow ecological limits doomed the

continuation of the stone-working, heaven-gazing, and wood-burning culture that

evolved there.

In general, through observation of the sun and the moon Neolithic peoples around

the world established markers, usually horizon markers, that monitored the

 

 

periodic motion of these bodies across the horizon and sky, tracked the year and

the seasons, and provided information of great value to communities of early

farmers. In some cases the devices they created to reckon the year and predict the

seasons became quite elaborate and costly and were possible only because of the

surplus wealth produced in favored places.

Before Stonehenge and long before the settlement and ruination of Easter Island, in

certain constricted environments growing populations pressed against even

enlarged Neolithic resources, setting the stage in Egypt, Mesopotamia, and

elsewhere for a great technological transformation of the human way of life—the

advent of urban civilization.

 

 

Wellness Promotion

/in /by

Wellness Promotion and the Institute of Medicine’s Future of Nursing Report Are Nurses Ready? This article highlights the gap between wellness in nursing practice and the mission statement of the Institute of Medicine’s Future of Nursing Report.

It explores wellness from 3 philosophical arguments, provides a historical evolution of wellness, and explores nurses’ current understanding of wellness. Future directions for implementing wellness in nursing practice are provided for science, education, and leadership. KEY WORDS: disease prevention, Institute of Medicine Future of Nursing Report, health promotion, wellness in nursing Holist Nurs Pract 2012;26(3):129–136

The Future of Nursing Report published by the Institute of Medicine (IOM) symbolizes a paradigm shift in health care delivery from sick care to well care.1 The IOM envisions a health care system where nurses intentionally promote wellness and disease prevention and improve health care outcomes throughout the lifespan.

1 The nursing profession is well recognized for the role of disease prevention and health promotion as established in the seminal article of Donaldson and Crowley2 to the recent Future of Nursing Report from the IOM.1 Within the scope of nursing practice, the words “health,” “health promotion,” and “wellness” appear to be used interchangeably.

Florence Nightingale, Virginia Henderson, and Margaret Newman developed frameworks that conceptualize wellness; however, wellness is not clearly defined within these theories.3–6

Nurses’ ability to achieve the mission of the IOM and intentionally promote wellness is limited by the absence of a universally recognized understanding of

Author Affiliation: School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.

The author thanks Elizabeth P. Howard, PhD, RN, ACNP, associate pro- fessor, School of Nursing, Bouvé College of Health Sciences, Northeastern University, for her time and support in editing the manuscript for publication.

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Kelley Strout, MSN, RN, c/o Elizabeth P. Howard, School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115 (Kelley.A.Strout@gmail.com).

DOI: 10.1097/HNP.0b013e31824ef581

the concept of wellness and a common paradigm to promote wellness in nursing practice.7 The purpose of this article is to conceptualize the historical evolution of wellness and highlight the gap in nursing practice between knowing and promoting wellness.

THE CONCEPT OF WELLNESS

The absence of a universally recognized concept of wellness in the nursing profession is better understood after examining the complexity of wellness through 3 philosophical arguments: ontology, realism, and empiricism.

Plato’s ontological argument establishes wellness as a state of being. Patient lives represent diversity and ever-changing circumstances; patients will define what it means to be well based on their changing world. Their perception of wellness will generate from their current circumstances and will continuously change.

8 Thus, the concept of being well is not static, but fluid. According to Plato, all living things aim and aspire to “good being.” From this perspective, all people naturally hope to gravitate toward a state of wellness, or “good being.” As people experience enhanced wellness, they will become more self-aware and learn about additional experiences that will promote wellness.

Wellness is a process of becoming, a process that does not have an end point; therefore, every person strives for wellness throughout life. Wellness expands beyond health and does not simply apply to people in poor health, or people who need to

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130 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

prevent certain diseases. Every person continues on a journey to achieving his or her full potential and maximizing his or her wellness.8

The philosophical argument of realism aligns with the concept of wellness. Realism explains the reality of a phenomenon. Wellness from a realist perspective asks, “What is the reality of wellness? What does wellness look, act, and feel like? Wellness will look, act, and feel different for every patient. Realities are unique to individuals’ environments, genetics, and experiences.9 Patients’ realities will influence their views and perception of wellness.

Wellness embraces an empirical philosophy; however, this philosophy differs from empirical research and practice and expands to the patient’s experience. John Locke, a philosophical empirical thought leader, proclaims that knowledge is derived through experience.

8 Personal patient experiences will determine his or her definition of wellness. Nurses cannot possibly acquire the experience of each individual patient. Every patient who interacts with a nurse will possess different knowledge compared with the previous patient. Knowledge creates worlds for patients, worlds that translate into unique and diverse definitions and understandings of wellness.

Wellness is difficult to conceptualize, which may explain the omission in definition and paradigm development within the nursing profession. In the absence of a universal, clearly defined understanding of the word and concept of wellness, the National Wellness Institute10 provides this clear definition of wellness: wellness is a multidimensional and holistic state of being that is conscious, self-directed, and constantly evolving to achieve one’s full potential.

Wellness is an ever-changing process that encompasses multiple dimensions, known as the Six Dimensions of Wellness: intellectual, spiritual, emotional, physical, occupational, and social dimensions.10,11 The Six Dimensions of Wellness reflect unique characteristics that interconnect with one another to represent the person as a whole. Table 1 provides the definition for each of the Six Dimensions of Wellness.

HISTORY OF WELLNESS IN NURSING

According to the National Wellness Institute,10 a professional can determine whether he or she practices within a wellness approach if he or she answers “yes” to the following 3 questions: “Does this help patients

TABLE 1. Definitions of the Six Dimensions of Wellnessa

Dimension of Wellness Definition

Occupational wellness

Ability to contribute unique skills to personally meaningful and rewarding paid or unpaid work

Social wellness Ability to form and maintain positive personal and community relationships

Intellectual wellness

Commitment to lifelong learning through continuous acquisition of skills and knowledge

Physical wellness Commitment to self-care through regular participation in physical activity, healthy eating, and appropriate health care utilization

Emotional wellness

Ability to acknowledge personal responsibility for life decisions and their outcomes with emotional stability and positivity

Spiritual wellness Having purpose in life and a value system

aBased on definitions from Hettler.11

achieve their full potential? Does this recognize and address the whole patient? Does this affirm and mobilize positive qualities and strengths?”10 The nursing frameworks of Florence Nightingale, Virginia Henderson, and Margaret Newman are examined for congruency with wellness profession guidelines of the National Wellness Institute.

Florence Nightingale’s theory supports wellness by addressing the whole patient and affirming his or her positive qualities and strengths.6 Nightingale believed that patients should be placed in optimal environments that allow nature to act. Her theory promoted nature as the ultimate cure for any disease process. According to Nightingale’s theory, environments are multidimensional. The air people breathe, the food people eat, the company people keep, and the conditions people live will interact to promote or prevent healing.6

Nightingale believed that nurses should work to prevent disease and care for well patients with the same approach as caring for sick patients.6 She explained that diseases proliferate for years before manifesting into clinical symptoms. Therefore, nurses can improve the environment of well patients to prevent disease. Improving the environment could be

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Wellness Promotion 131

as simple as helping a patient create a healthy menu plan to helping a community improve air quality. Nightingale encouraged nurses to empower society to improve environments outside hospitals such as schools, homes, and communities in order to prevent disease.6

Nightingale’s theory represents affirming and mobilizing positive qualities within patients.6 She believed that the patient, whether sick or well, is the best person to care for his or her own health. She encouraged nurses to view patients in the moment. She warned nurses not to judge patients with condescending thoughts or words. Nightingale believed that nurses should recognize that patients would do better in a supportive environment.6

Nightingale’s theory of placing the patient in an optimal environment for healing and preventing disease promotes a wellness approach by addressing the patient positively and holistically. However, Nightingale does not define well, or wellness. Through her descriptions, the state of wellness is reflected by the absence of disease. Nightingale’s theory does not support the concept of assisting patients to achieve their full potential. Patients who are not sick are not necessarily achieving their full potential.6 The absence of disease is not reflective of full potential.10

Henderson’s theory supports wellness by addressing the patient from a multidimensional perspective and encourages them to provide their own care.3 In Henderson’s complex, multidimensional model, she defines health as a person’s ability to perform 14 activities independently.3 Although the word “wellness” is not used in Henderson’s theory, her activities align with the Six Dimensions of Wellness framework.11 Table 2 organizes Henderson’s theory in the Six Dimensional Framework.

Henderson believes that the nurses’ role is to assist patients with the 14 activities when they lack the strength, knowledge, or will. At the same time, she emphasizes that nurses should care for all patients; she believes that basic human needs exist in patients who are sick and patients who are well. She believes that nurses should promote health and prevent disease.3

Henderson’s theory affirms and mobilizes the strength of patients. She further states that nurses must encourage and empower patients to care for themselves.3 Nurses should not do everything for a patient; the best care is the care that the patient gives himself or herself. Nurses should recognize that health is multidimensional and affected by variables such as

TABLE 2. Henderson’s Definition of Health and the Six Dimensions of Wellness Frameworka

Dimension of Wellness

Fourteen Activities That Define Health

Occupational wellness

Work at something that provides sense of accomplishment

Social wellness Avoid dangers in environment and avoid injuring others

Play or participate in various forms of recreation

Intellectual wellness

Learn, discover, or satisfy the curiosity that leads to “normal” health

Physical wellness Eat/drink adequately Move and maintain desirable posture Sleep/rest

Emotional wellness

Communicate with others in expressing emotions, fears, and needs

Spiritual wellness Worship according to his or her faith

aBased on definitions from Henderson3 and Hettler.11

age, environment, genetics, culture, emotional balance, and intellectual abilities.3

Henderson encourages nurses to also care for well people. She defines health as the ability to perform 14 functions independently. Although Henderson encouraged and believed that nurses should provide care to well patients, not just sick patients, she never provided an explanation for how the nurse would care for a patient who could independently perform the 14 functions. Her theory addresses patients holistically and promotes affirmation; however, similar to Nightingale, her theory does not address helping the person achieve his or her full potential or maximal level of wellness. She defined health and even emphasized the nurses’ role in caring for well patients, but she did not define wellness, nor did she provide a framework to promote wellness.

Newman’s theory, Health as an Expanding Consciousness, supports 3 wellness approaches: addressing the whole patient; assisting the patient to rise to his or her full potential; and affirming the qualities within a patient.4 In Newman’s theory, disease is an underlying manifestation of an imbalance within a patient. Health is more than the absence of disease; health is the expansion of consciousness, or personal growth. Newman’s theory supports the idea that even in the face of illness, a patient can grow and make progress. Although disease appears negative, Newman believes that disruption eventually

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132 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

transforms a patient’s life into a higher state of being, or consciousness.4

Health as a state of consciousness, according to Newman, is represented through the quality and interaction of a patient with his or her environment. Newman addresses the complexities that exist between every individual and his or her environment. Every patient’s relationship with his or her environment will generate different reactions. The reflections on experiences that occur within the environment provide growth or expanded consciousness. Newman stresses that for nurses to promote expanded consciousness, they must provide highly individualized care to every patient. She also believes that the process of expanding consciousness can occur anywhere, anytime. The process is not limited to a specific health care setting, or the presence or absence of a disease.4

Nurses’ responsibility in promoting consciousness reflects the wellness approach of affirming and addressing the whole person. Newman believes that to promote consciousness, nurses need to look at patients as a whole, greater than the sum of their physiologic systems. Health is not something someone achieves or loses. Patients can have consciousness even in the face of illness and disease; you cannot lose consciousness or achieve consciousness. Illness or diseases create an opportunity for growth.4

For optimal effectiveness of Newman’s model, the relationship and environment created between a person and a nurse are essential. Nurses must provide individualized care focused on listening attentively to the person’s life, and rhythm. Nurses need to embrace uncertainty and not focus on fixing the patient but, instead, listen and promote what is working well. People’s lives are not certain, they are all different and unique; disequilibrium is necessary for growth. Nurses need to give patients the opportunity to reflect, think, and generate their own growth. Nurses cannot manipulate and control patients; the partnership between nurses and patients is essential to expanding consciousness.12

Newman’s theory embraces the concept that wellness is a state of being, ever changing and continuously evolving. Newman does not use the word “wellness” to describe her theory; however, her theory suggests that nurses cannot define wellness for patients because wellness will mean something different to every patient. Nurses need to promote wellness by accepting uniqueness and developing a deep understanding for each patient’s environment and experience.

Although each of the theorist believe that caring for patients who are well is essential to the nurses’ role, none clearly define the concept of wellness or provide a framework for nurses to practice and promote wellness.3,4,6,12 To examine the relationship between the theoretical foundations of wellness and current nursing practice, a review of the literature was completed using CINHAL. Literature examining the role of wellness in nursing practice was notably absent. The CINHAL thesaurus suggested using the search terms “health promotion.” Five qualitative research studies aiming to explore nurses’ perceptions of the definition of health promotion, how they promote health in practice, and barriers to promoting health in practice were included in the review. The sample sizes ranged from 8 to 20. Nurses working in acute care, geriatrics, advanced practice, academia, community, and mental health care were represented. Because of the expanded search, a definition of health promotion is provided in the following text.

HEALTH PROMOTION

The World Health Organization13 defines health promotion as a process to help individuals increase control of their health with the desired outcome of physical, mental, and social well-being. The World Health Organization distinctly emphasizes that before health promotion can occur, a patient must recognize his or her aspirations, satisfy his or her needs, and change or cope with his or her environment. Health and wellness promotion is a fundamental role within the nursing profession, yet a review of the literature highlights a gap in nursing knowledge about how and when to promote health and wellness.

NURSES DEFINITION OF HEALTH PROMOTION

The results of 5 qualitative research studies suggest that nurse’s definition of health promotion is ambiguous and uncertain.14-18 The common definition of health promotion among nurses, in a variety of health care settings, refers to providing health education and advice about healthy life styles.15-18 For example, nurses believed that health promotion is telling someone why he or she should change his or her behavior or life to protect or improve his or her

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Wellness Promotion 133

health.18 Nurses with more experience commonly perceived health promotion as empowerment.17

Advanced practice nurse practitioner students with at least 2 years of nursing experience participated in a research study that evaluated their perceptions of health promotion. The students completed qualitative questionnaires before and after a health promotion course. Before the health promotion course, the students described health promotion as advice giving and health education. After the health promotion course, the student’s views of health promotion evolved to empowering the patient.18

HOW NURSES PROMOTE HEALTH

In the research studies included in the review, the most common theme about how nurses promote health is giving information about healthy lifestyles to patients with specific health conditions.16-18 For example, if a patient presented to the hospital post–myocardial infarction, the nurse would encourage the patient to exercise more frequently and eat more fruits and vegetables.16 Some nurses believe that they promote health without any deliberate efforts because promoting health is a natural and automatic component to their work. Consequently, they are unable to recall specific examples about the last time they promoted health.15

BARRIERS TO HEALTH PROMOTION

The most common perceived barrier to promoting health in nursing practice is time,15,17,18 followed closely by not enough education and training.15,17

Some nurses believe that they needed more evidence that health promotion is an effective method for helping patients improve their health.17

Nurses perceive patients as barriers to promoting health. Some nurses believe that patients are unwilling to accept health promotion.15 More than half of nurses who perceived that patients should not have a choice to receive health promotion believed that patients frequently ignore advice given to them.17 Patients’ knowledge deficit about healthy lifestyles and patients’ unwillingness to change emerged as health promotion barriers for nurses.18

The health care system and work environments do not support nurses in the role of health promotion.14,15,18 Some nurses believed that nursing

management does not empower nurses to promote health and daily nursing tasks are burdensome and prevent them from practicing health promotion.15 The percentage of nurse practitioner students who perceived the work environment as a barrier to practicing health promotion increased at the completion of a health promotion course.18

DISCUSSION

The literature included in the review contains limitations. The most notable limitation is the absence of literature examining nurses’ perception of wellness in practice. The vision of the IOM is for nurses to intentionally promote wellness. Before this can occur, research that examines nurses’ current understanding of wellness and how to promote wellness in practice is needed. Research in this review contained small, convenience samples of nurses who were required to answer questions about health promotion while being recorded by the interviewer. Nurses interested in health promotion may be overrepresented using convenience samples. Furthermore, the use of tape recorders may lead some nurses to withhold information or exaggerate information due to concerns about confidentiality, or social desirability. Acknowledging the limitations, however, this review provides insight about the gap between wellness promotion and nursing practice.

Nurses believe that health promotion is at the core of nursing practice.15-18 Currently, nurses promote wellness by promoting health. Nurses cannot intentionally promote wellness and achieve the vision of the IOM1 if they are unable to confidently define and provide specific examples of health and wellness promotion. Nurses should have time to promote health and wellness if they believe that it is the core of the profession.

Nurses believe that patients are barriers to the practice of health promotion.15-18 Nurses’ belief that patients are unwilling to accept health promotion warrants further examinations. How can patients have knowledge deficits about their own perception of health and wellness? If a patient is unwilling to change, should he or she be considered a barrier? Reflecting on each question philosophically reminds us that patients’ health and wellness are their own state of being. Their experiences and perceptions define how wellness and health will look, act, and feel for them.8,19 According to ontology, every patient is

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134 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

on a journey to optimal wellness.8 Reflecting on each question through the lens of nursing theorists suggests that nurses may be the true barriers in promoting health. Nightingale warns against judging patients who are unwilling to change. She would say that patients would do better if their environment supported them better.6 Henderson3 would argue that the patient does not have the strength, knowledge, or will to accept health promotion how the nurse desires, but this does not mean that the patient never wants to promote his or her health. Newman12 posits that the nurse is not asking the right questions, not listening with her whole heart, and not getting into the patient’s life.

WELLNESS AND THE ART AND EPISTEMOLOGY OF NURSING

The review of the literature highlights a gap between nurses’ perception of health and wellness promotion in nursing practice and how and when to promote health and wellness in practice. The subjective nature of wellness, the absence of a clear and universal wellness definition, and the absence of a wellness framework in nursing practice create fundamental challenges to achieving the IOM’s vision.1 Nurses need to know how to assess, design, document, and validate wellness outcomes. Carper’s20 seminal work, The Four Fundamental Patterns of Knowing in Nursing, provides a framework to address the art and epistemology of wellness in nursing.

Empirical understanding of wellness

Nurses need an empirical understanding of the concept of wellness. To intentionally promote wellness, nurses need to know in what context the phenomena of wellness are to be viewed. Nurses need to develop an abstract and theoretical explanation for wellness in nursing practice. Nurses need to know what questions are to be raised about wellness, and the methods of study to examine evidence of wellness promotion.2 For nurses to intentionally promote wellness in nursing practice, they need the knowledge to describe and explain wellness to patients, society, and other health care professionals.

In nursing practice, the essence of wellness may lie within an understanding of the realities, experiences, and world of the patient. Nurses, therefore, will need to know how to empower, encourage, and inspire patients to realize their own visions of wellness. Nurse

researchers need to design empirical studies to examine techniques to promote wellness in nursing practice. Nurse educators need to develop frequent continuing educational activities about when, how, and why to promote wellness in practice. Nursing administration needs to examine nursing tasks to ascertain whether health and wellness promotion, a core value in nursing, is not absent in practice because of time constraints. Nursing practice needs to develop a documentation system that captures the patient’s empirical view of wellness and tracks wellness outcomes from the patient’s perspective. Most importantly, nursing education needs to develop an evidenced-based curriculum that provides nurses with a strong foundation for promoting wellness in nursing practice. Currently, clinical prevention and population health are essential education requirements for baccalaureate prepared nurses.21 These requirements do not aim to prepare all nurses for the role of intentional wellness promoters. First, clinical prevention, as defined by the American Association of Colleges of Nursing, is disease focused. Nurses practicing clinical prevention will demonstrate knowledge around immunizations, screenings, and counseling aimed to prevent disease or disease escalation. Second, population health aims to improve the health at the community, or aggregate, level. However, since the baccalaureate degree is the minimum level of education required to practice and promote population health, half of the nursing workforce who hold an associate degree in nursing is not adequately trained or qualified to perform this role21,23 The absence of wellness as an essential requirement in nursing education is evident. To achieve the vision of the IOM, all licensed nurses require education and training about the meaning of wellness and how to promote wellness to all patients in all care settings.

Esthetic understanding of wellness

An esthetic understanding of how to promote wellness in nursing practice is needed. Wellness is intimate to the person experiencing the phenomenon. Successful wellness promotion in nursing practice will depend on how nurses ask patients questions about what wellness means to them. Patients’ responses will depend on how nurses listen to the words the patients speak and how nurses insert themselves into the patients’ world.4,20

The patients’ growth will depend on nurses’ ability to

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Wellness Promotion 135

be in the moment; nurses will express empathy, joy, and heart ache with the patients to promote wellness.20

Personal understanding of wellness

Nurses need a personal understanding of how to promote wellness in nursing practice. Personal knowledge in wellness promotion will require nurses to relinquish the authoritarian role and accept that patients are free to create their meaning and experience of wellness.20 Carper20 states, “An authentic personal relation requires the acceptance of others in their freedom to create themselves and the recognition that each person is not a fixed entity, but constantly engaged in the process of becoming.”(p155)

Nursing practice needs to develop dynamic relationships with policy makers and interdisciplinary health care professionals to design a wellness infrastructure within the community and the health care system. The new system should capitalize on nurses’ personal knowledge and ability to promote wholeness and integrity.20

Ethical understanding of wellness

Nurses need an ethical understanding of how to promote wellness in nursing practice. Patients’ perception of wellness will depend on their experiences and values. Only patients can determine what is good and bad for them. However, nurses need the knowledge to recognize behavior that is harmful or dangerous. Nurses need to adhere to moral obligations when promoting wellness in nursing practice.20

FUTURE DIRECTION FOR SCIENCE AND NURSING

Nurses are recognized for their unique ability to care for patients holistically.23 The goal of nursing practice is to foster behavior that leads to health and wellness.2

However, nurses cannot rise to their full potential and realize the vision of the IOM1 to intentionally promote wellness based on this premise.2,23 Nurses need a clear understanding of the phenomenon of wellness. Nursing science needs to develop a universal wellness paradigm to promote wellness in nursing practice.7

Finally, the pivotal change that needs to occur is a shift in the percentage of nurses working in acute care hospital settings to nurses promoting wellness within the community. Currently, 62.2% of nurses work in

hospitals compared with 7.8% in public health and community settings.22 Patients in acute care settings are in a new environment. Before optimal health and wellness promotion can occur, patients must cope with the new environment, a process that may not occur before patient discharge.13

Nurses’ role in the community is multidimensional. Nurses have an opportunity to apply empirical, aesthetic, personal, and ethical wellness knowledge in schools, businesses, prisons, day care centers, and any other place people gather. Removing the barrier of the hospital environment14,15,18 may prove the best method for nurses to assume their role as intentional promoters of wellness.

CONCLUSION

The Future of Nursing Report from the IOM1

symbolizes a turning point for change in health care delivery. Nurses are prepared to rise to the challenge and embrace changes that promote positive health outcomes for society. However, to realize a vision that explicitly emphasizes the contribution of intentional wellness promotion to positive patient outcomes, nurses are challenged to develop a universal understanding and paradigm to promote wellness in nursing practice. Before nurses can value their role as wellness promoters, nursing education, nursing research, and nursing administration need to work together to make wellness a priority. Without proper education about how and why to promote wellness, without research to provide evidence-based wellness guidelines, and without administration to monitor wellness promotion practice and outcomes, nurses cannot truly value their role as intentional wellness promoters.

REFERENCES

1. Institute of Medicine. The Future of Nursing: Leading Change, Advanc- ing Health. Washington, DC: National Academies Press; 2011.

2. Donaldson SK, Crowley DM. The discipline of nursing. Nursing Out- look. 1978;26(2):113-120.

3. Henderson V. The concept of nursing. 1977. J Adv Nurs. 2006;53(1): 21-31.

4. Newman MA. Evolution of the theory of health as expanding conscious- ness. Nurs Sci Q. 1997;10(1):25.

5. Newman MA. A world of no boundaries. Adv Nurs Sci. 2003;26(4):240- 245.

6. Nightingale F. Notes on Nursing What It Is, and What It Is Not. New York, NY: D Appleton & Company; 1860.

7. Mackey S. Towards an ontological theory of wellness: a discussion of conceptual foundations and implications for nursing. Nurs Philos. 2009;10(2):103-112.

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8. Shand J. Philosophy and Philosophers: An Introduction to Western Phi- losophy. Montreal, Quebec, Canada: McGill-Queen’s University Press; 2002.

9. Kim H. Identifying alternative linkages among philosophy, theory, and method in nursing science. J Adv Nurs. 1993;18:793-800.

10. Hettler B. BALANCE: The Six Dimensions of Your Life. http:// hettler.com/meec2007/index.htm.

11. Hettler B. The Six Dimensions of Wellness. Stevens Point, WI: National Wellness Institute; 1976.

12. Newman MA. The rhythm of relating in a paradigm of wholeness. J Nurs Scholarsh. 1999;31(3):227-230.

13. World Health Organization. The Ottawa Charter for Health Promotion: First International Conference on Health Promotion; November 21, 1986; Ottawa, Ontario, Canada.

14. Burman ME, Hart AM, Conley V, Brown J, Sherard P, Clarke PN. Reconceptualizing the core of nurse practitioner education and practice. J Am Acad Nurse Pract. 2009;21(1):11-17.

15. Casey D. Nurses’ perceptions, understanding and experiences of health promotion. J Clin Nurs. 2007;16(6):1039-1049.

16. Irvine F. Examining the correspondence of theoretical and real inter- pretations of health promotion. J Clin Nurs. 2007;16(3):593-602.

17. Kelley K, Abraham C. Health promotion for people aged over 65 years in hospitals: nurses’ perceptions about their role. J Clin Nurs. 2007;16(3):569-579.

18. Rash E. Advanced practice nursing students’ perceptions of health pro- motion. South Online J Nurs Res. 2008;8(3):11.

19. Godfrey-Smith P. Theory and Reality: An Introduction to the Philoso- phy of Science. Chicago, IL: University of Chicago Press; 2003.

20. Carper B. Fundamental Patterns of Knowing in Nursing [dissertation]. New York, NY: Teachers College, Columbia University; 1975.

21. American Association of Colleges of Nursing. The essentials of bac- calaureate education for professional nursing practice. http://www.aacn. nche.edu/education-resources/essential-series. Published 2008.

22. US Department of Health and Human Services, Health Resources and Services Administration. The Registered Nurse Population: Initial Find- ings From the 2008 National Sample Survey of Registered Nurses. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration; 2010.

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.